Comprehensive Case Formulation: Bill, a 66-year-old retired structural engineer, has been referred to the Buckingham primary care service, Talking Therapies, for an assessment for psychological therapy. Bill's wife, Martha, is 62 years old and works as an accounts manager. She has been recovering from cardiac ablation for atrial fibrillation and has been on sick leave. Bill and Martha have two adult children; Sarah who lives in Belfast with her two children, and Thomas who is recently divorced and lives locally but commutes to London for work.Bill is experiencing intense anxiety symptoms, including dizziness, nausea, dry mouth, racing heart, and fear of sudden death. He is monitoring his blood pressure three times a day, avoiding strenuous exercise, and has stopped driving. He has been calling his GP 2-3 times a week and called an ambulance, fearing he was having a heart attack. His recent behavior has caused several arguments with his wife, and he is currently sleeping in the spare room. During the assessment, Bill was observed to be drinking excessive amounts of water.Bill's childhood experiences may have contributed to his current symptoms. He grew up in a rural part of Cumbria with his parents and twin brother, Phil, who has struggled to hold down any consistent employment. His mother now lives in a care home in a small town near where he grew up. She has struggled financially since his father died suddenly at age 64. Bill has made several trips by train to visit her in the past few months.Possible Aetiological Factors:Bill's anxiety symptoms may be related to a combination of biological, psychological, and social factors. Biological factors, such as genetics and neurochemistry, may affect his anxiety disorder. Psychological factors, such as his childhood experiences and current stressors, may contribute to his symptoms. Social factors like his family and work situation may also impact his anxiety.Research has identified several risk factors for anxiety disorders, including a family history of anxiety, childhood trauma, low socioeconomic status, and chronic stress. Bill's childhood experiences and current stressors, including his mother's financial struggles and his wife's illness, may contribute to his anxiety symptoms.

Provide a comprehensive case formulation (supplying supplementary case material if you need to) and refer to the research literature concerning possible aetiological factors

Provide a detailed treatment plan that uses cognitive behavioural therapy (CBT) OR provide a narrative account of the CBT that has been conducted with you as therapist

Suggest community resources that may contribute to improved outcomes in line with the biopsychosocial model